P1726: NON-PHARMACOLOGICAL INTERVENTIONS FOR SYMPTOM MANAGEMENT AND QUALITY OF LIFE IN PATIENTS WITH HEMATOLOGICAL MALIGNANCY: A SYSTEMATIC REVIEW OF RANDOMIZED TRIALS
Authors: M. Pedersen, M. Schaufuss Engedal, B. Kornblit, M. Torp Larsen, K. Lomborg, M. Jarden
Journal: HemaSphere (2022)

Background: Non-pharmacological interventions have been developed and tested in patients with hematological malignancy as patients experience debilitating and persistent symptoms affecting everyday life. Hematological malignancies are a diverse and complex group of diseases and treatment regimens vary from aggressive chemotherapeutic treatments, to daily or weekly treatment regimens, or ‘watch and wait’ strategies. Therefore, for many patients the diagnosis is an incurable chronic condition characterized by multiple exacerbations, functional impairment and a high symptom burden affecting quality of life with negative consequences for optimal treatment, survival, return to work, and daily activities. As pharmacology is not always possible or optimal in managing symptoms there is a need for non-pharmacological interventions targeted this population. However, evidence collating the impact of non-pharmacological interventions is sparse. Aims: To identify and provide a summary of types of non-pharmacological interventions that measure symptoms and quality of life investigated in randomized controlled trials in patients with hematological malignancies. Methods: A protocol of this study was registered at the international register of systematic reviews PROSPERO (Registry no. CRD42021237344). A systematic search for articles was conducted until April 20, 2021 in Medline, Embase, Cinahl, APA PsycInfo and Central Cochrane. This systematic review followed the PRISMA guidelines, and applied Cochranes Risk of Bias tool (Rob2). Results: There were 14.610 studies identified through the initial search. After removal of duplicates (n=2223), 12.387 studies remained. Sixty-four articles were included after full-text screening. The non-pharmacological interventions were divided into five types across 12 hematological diagnosis or treatment groups; i) Exercise (n=36), ii) Mind/body (n=9), iii) Clinical consultation-based (n=4), iv) Music and Art (n=6) and v) Tele-health and App-based (n=9) measuring symptom and quality of life outcomes along the disease and treatment trajectory. Overall patients with leukemia were dominant within mind/body interventions, whereas HSCT patients were mainly tested in music/art and exercise interventions. Fatigue was improved significantly in patients testing tele health care (n=3), mind/body interventions (n=2) and several exercise interventions. Depression and anxiety decreased following clinical palliative consultation care (n=2), music/art (n=2) and mind/body interventions (n=3). Except for one study (music/art) all the interventions found improved patient quality of life. Studies included had divergent quality assessments assed with ROB2. Summary/Conclusion: Different types of non-pharmacological interventions had varying effects on managing symptoms and in improving quality of life. Symptoms of fatigue, anxiety and depression and quality of life were most frequently investigated, and significant positive effects of non-pharmacological interventions were found on several studies.